Malawer type I/V proximal humerus reconstruction after tumor resection: a systematic review

BACKGROUND

Several reconstruction methods exist for Malawer type I/V proximal humerus reconstruction after bone tumor resection; however, no consensus has been reached regarding the preferred methods.

METHODS

We conducted a literature search on various types of proximal humerus oncologic reconstruction methods. We collected data on postoperative functional outcomes assessed based on Musculoskeletal Tumor Society (MSTS) scores, 5-year reconstruction survival rates, and complications. We calculated each reconstruction's weighted mean based on the sample size and standard errors. Complications were categorized based on the Henderson classification. Based on these integrated data, our primary objective is to propose an optimal strategy for proximal humerus reconstruction after bone tumor resection.

RESULTS

We examined various reconstruction techniques, including modular prosthesis (752 patients in 21 articles), osteoarticular allograft (142 patients in 6 articles), allograft prosthesis composites (APCs) (236 patients in 12 articles), reverse shoulder total arthroplasty (141 patients in 10 articles), composite reverse shoulder total arthroplasty (33 patients in 4 articles), claviculo-pro-humero (CPH) technique (51 patients in 6 articles), and cement spacer (207 patients in 4 articles). Weighted mean MSTS scores were: modular prosthesis (73.8%), osteoarticular allograft (74.4%), APCs (79.2%), reverse shoulder total arthroplasty (77.0%), composite reverse shoulder total arthroplasty (76.1%), CPH technique (75.1%), and cement spacer (69.1%). Weighted 5-year reconstruction survival rates were modular prosthesis (85.4%), osteoarticular allograft (67.6%), APCs (85.2%), reverse shoulder total arthroplasty (84.1%), and cement spacer (88.0%). Reconstruction survival data was unavailable for composite reverse shoulder total arthroplasty and CPH technique. Major complications included shoulder joint instability: modular prosthesis (26.2%), osteoarticular allograft (41.5%), APCs (33.9%), reverse shoulder total arthroplasty (17%), composite reverse shoulder total arthroplasty (6.1%), CPH technique (2.0%), and cement spacer (8.7%). Aseptic loosening of the prosthesis occurred: modular prosthesis (3.9%) and reverse shoulder total arthroplasty (5.7%). Allograft fracture was observed in 54.9% of patients with osteoarticular allograft.

CONCLUSION

The complication profiles differed among reconstruction methods. Weighted mean MSTS scores exceeded 70% in all methods except cement spacer, and the 5-year reconstruction survival rate surpassed 80% for all methods except osteoarticular allograft. Proximal humerus reconstruction after bone tumor resection should consider potential complications and patients' individual factors.

Functional outcome and multidimensional evaluation of patients with Mutars® reconstructions post lower limb tumor resection and rehabilitation: preliminary results

Modular prostheses are commonly used to reconstruct defects of the distal femur and proximal tibia after bone tumor resection. Improving patient's autonomy and giving them a better quality of life are the main goals. Post-surgical rehabilitation is very relevant after surgery. The aim of this paper is to study the short and mean time functional outcomes in patients treated with Mutars® reconstructions after proximal and distal lower limb tumor resection with a multidimensional analysis and a standardized stabilometric examination. Twenty-one patients (7 male and 14 women, mean age and standard deviation: 61.76±14.68) affected by primitive bone tumor (28.6%) or metastatic bone tumor (71.4%), treated with MUTARS® reconstructions after proximal (71%) , distal(23.8%) and both (4.8%) lower limb tumor resections, accepted to take part to the study. They were evaluated after one week (T0), one month (T1), three months (T2), six months (T3) and one year (T4) after surgery with standardized clinic evaluation and with multidimensional validated scales. Visual Analogic Scale (VAS during active movement), Short Physical Performance Battery (SPPB), Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Status (KPS), MusculoSkeletal Tumor So¬ciety rating (MSTS), Toronto Extremity Salvage Score scale (TESS). Patients underwent to an instrumental standardized stabilometric test after one month from surgery and in following evaluations to measure stand¬ing balance. Patients underwent to a rehabilitation program during three months after surgery. There was a significant improvement of hip flexion range of movement (p level: 0.008), and gait modalities (without aids) after three months from surgery (p level 0.02). There was a significant reduction in VAS after one month of surgery (p level 0.00). It was observed an increase of the SPPB value at T3 (p level 0.01), of MSTS and TESS at T2. Balance stabilometric evaluation did not showed significant increase at each timing also if Romberg perimeter decrease progressively. These preliminary results showed that, oncological patients, affected by bone tumors or metastasis, surgical treated with MUTARS® implant and admitted to the rehabilitation programs, can improve their gait modalities and functional daily life outcomes, until three months from surgery. A large sample will allow, necessary to define standardized rehabilitation protocols after oncological orthopedic sur¬gery, in order to introduce guidelines that can be applied routinely.

Particular Characteristics of Medical Rehabilitation in Patients Operated for Osteoarticular Tumors according to the Campanacci Method

The modern treatment of the osteoarticular tumors requires a multidisciplinary approach. Due to their proximity to major neural and vascular pathways, to the fact that they affect young people, as well as because they can permanently impair the functionality of the limb, the preoperative assessment of the patients must be performed in detail (physical, imaging, biochemical and histological examination) in order to prepare for the surgical procedure with a minimum impact on the quality of the life of the patients. In the last 5 years, in the Clinic of Orthopedics of the Universitary Emergency Hospital of Bucharest 7 patients, aged between 25 and 40 years, with giant cell tumor were operated, the sex ratio being F/M : 5/2. The surgical procedures were radical, followed by adjuvant treatment and supportive therapy. The decision to follow a certain treatment must be taken with the full consent of the patient, taking into account the requirements of his/her daily life. The surgical intervention must have the full support of the teams of kinesitherapists, psychologists/psychiatrists and social worker. In these situations, the social integration was faster and the arthrodesis, as a therapeutic stage, was more easily accepted.

Clinical and radiological outcomes of combined modular prothesis and cortical strut for revision proximal femur in giant cell tumor of bone patients

BACKGROUND

Femoral bone deficiency is a challenging problem in revision proximal femoral replacement. The purpose of this study is to evaluate the clinical and radiological outcomes of revision proximal femoral replacement as a salvage treatment for severe bone loss after oncologic proximal replacement surgery in patient with benign giant cell tumor of bone.

METHODS

16 patients (6 men and 10 women) were included in this retrospective study, with a mean age of 46.6 year at the time of revision surgery. All patients underwent revision proximal femoral replacement with the use of modular prosthesis and cortical strut allografts. The modified Harris Hip Score, Short Form 36, and musculoskeletal Tumor Society Score were used for patient evaluation. Regular follow-up was performed to evaluate the recurrence and metastases rate, limb function, and long-term complications of patients.

RESULTS

The average follow-up was 46.3 months (range, 26-75 months), during which there was no local recurrence and metastases of patient. At the latest follow-up, the mean modified Harris Hip Score was 70.6 points, which was significantly improved compared with that of preoperative (p < 0.05). The final follow-up results of Short Form 36, Musculoskeletal Tumor Society Score, and limb-length discrepancy were also significantly improved compared to that of preoperative (p < 0.05). At the latest follow-up, the implanted femoral stems were all stable and all cortical strut allografts were also incorporated to their own bone.

CONCLUSION

Using modular prosthesis and cortical strut allografts in revision, proximal femur replacement is an acceptable procedure for relatively young patient with severe proximal femoral bone loss after oncologic surgery with benign giant cell tumor of bone. More attentions should be paid to reduce the risk of complications in these complex reconstructions.